Presentation on theme: "Medical Nutrition Therapy in Cardiovascular Disease"— Presentation transcript:
1Medical Nutrition Therapy in Cardiovascular Disease Chapter 35Medical Nutrition Therapy in Cardiovascular Disease
2Coronary Heart Disease (CHD) or Coronary Artery Disease (CAD) Disease involving the network of blood vessels surrounding and serving the heartManifested in clinical end points of myocardial infarction (MI) and sudden death10
3Cardiovascular Disease (CVD) CVD has been the leading cause of death in the United States for every year since 1900, exceptCVD kills almost as many people yearly as the next seven causes of death combined.
4Prevalence and Incidence The United States ranks 14th and 16th, among industrialized nations for the prevalence of CVD in women and men, respectively.More than 61 million Americans have at least one form of CVD (i.e., hypertension, CHD, stroke, rheumatic heart disease, or congestive heart failure).The incidence of CHD is high; an American experiences a coronary event almost every 29 seconds.
5Natural Progression of Atherosclerosis (From Harkreader H. Fundamentals. Philadelphia: W.B. Saunders, 2000)
6Plaque That Has Been Surgically Removed from Coronary Artery Courtesy Ronald D. Gregory and John Riley, MD.
7Prevention Blood lipids and lipoproteins Total cholesterol Total triglyceridesLipoproteins and metabolism—Chylomicrons, VLDL, IDL, LDL, HDL
8Functions of the Plasma Lipoproteins Chylomicron—Transport of dietary triglycerideVLDL—Transport of endogenous triglycerideIDL—LDL precursorLDL—Major cholesterol transport lipoproteinHDL—Reverse cholesterol transport
9Lipoprotein Assessment Includes measurement of total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride level after fasting
10Cardiovascular Risk Factors Category I—cigarette smoking, LDL cholesterol, high-fat diet, hypertensionCategory II—diabetes mellitus, physical inactivity, HDL cholesterol, TG, obesityCategory III—psychosocial factors, lipoprotein a, homocysteineCategory IV—age, male gender, low socioeconomic status, family history
11Quantity of Soluble Fiber Needed Daily to Produce Lipid-Lowering Effect Pectin: 6 to 40 gGums: 8 to 36 gDried beans or legumes: 100 to 150 gDry oat bran: 25 to 100 gOatmeal: 57 to 140 gPsyllium: 10 to 30 g
13Nutrient Composition of the Therapeutic Lifestyle Change Diet Saturated fatPolyunsaturated fatMonounsaturated fatTotal fatCarbohydrateFiberProteinCholesterolTotal calories (energy)
14Category I Risk Factors for Coronary Heart Disease Cigarette smokingElevated LDL and total cholesterolHypertensionLeft ventricular hypertrophy (LVH)Thrombogenic factors
15Category II Risk Factors for Coronary Heart Disease Diabetes mellitus types 1 and 2Physical inactivityLow HDL cholesterolObesityMenopausal factors
16Major Disease Processes Contributing to Coronary Heart Disease Atherosclerosis—chronic (long-term development)Thrombosis—acute (late and brief event)
17Pathophysiologic Steps in Development of Coronary Heart Disease/Myocardial Infarction Phase 1 Fatty streaks (atherogenesis)Phase 2 Atheroma (or plaque) formationPhase 3 Complicated lesions with rupture (nonocclusive thrombosis)Phase 4 Complicated lesions with rupture and occlusive thrombosisPhase 5 Fibrosis (occlusive) lesions
18Hyperlipidemias Elevated blood triglycerides and/or cholesterol Lipoproteins found in bloodChylomicrons = postprandial dietary fatVery-low-density lipoproteins (VLDL) = lipid being transported from liver to peripheral tissueLow-density lipoproteins (LDL) = transport of cholesterolHigh-density lipoproteins (HDL) = reverse transport of cholesterol, tissues to liverType of hyperlipidemia depends upon portion of particles present5
21LDL Cholesterol Levels Predict Risk of Coronary Heart Disease Increased byFat in dietObesityDiabetesHypothyroidismDecreased byEstrogen11
22Primary Prevention with Lipoprotein Analysis (From National Cholesterol Education Program: Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). National Institutes of Health, NIH Publication No Bethesda, MD: National Heart, Lung, and Blood Institute, 1993.)
23Primary Prevention in Adults without Evidence of CHD: Initial Classification Based on Total Cholesterol and HDL Cholesterol(From National Cholesterol Education Program: Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). National Institutes of Health, NIH Publication No Bethesda, MD: National Heart, Lung, and Blood Institute, 1993.) HDL = high-density lipoprotein.
24Diet Therapy for High Blood Cholesterol (Data from National Cholesterol Education Program [NCEP]. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel II]. NIH Publication N Bethesda, MD; National Institutes of Health. National Heart, Lung, and Blood Institute, 1993.) * Calories from alcohol not included.
25General Goals for Treatment of Hyperlipidemias Achieve IBW.Decrease simple sugars and alcohol.Decrease total fat, especially cholesterol and SFA.Increase complex carbohydrate and fiber.6
26Lipid-Lowering Drugs Added if Diets Are Not Successful After a 6-month trial on each diet, drugs are added to the treatment.Types:Nicotinic acid and lovastatinGemfibrozil, probucol, clofibrate— for high TGsCholestyramine and colestipol (bile acid sequestrants)—to lower high cholesterol; may increase TGs8
27Myocardial Infarction (MI) Coronary Infarction, Coronary Thrombosis, or Heart Attack Some part of coronary circulation blockedIschemia leads to muscle destructionDiagnosis: ECG; blood levels of enzymes such as LDH and CPK14
28Myocardial Infarction—MI Postinfarction nutrition1. 1st 24 hrs: no caffeine, liquid diet(nausea and choking are common)2. Small frequent meals; soft or liquid diet3. Na+ restriction if BP and fluid status indicate4. Consistent diet information5. Drugs that cause nausea—digitalis, morphine15